KDS Beauty and Wellness School Intake Application General Questions: Program:Esthetics Licensed ProgramAdvance Ayurvedic Esthetics Spa ProgramMakeup and Hair Program Personal Information: Gender : MaleFemaleOther Birthday : Application Specific Questions: How important would you rate these areas of your life to be? Circle the number that best reflects the importance to you- 1 being the lowest importance and 10 being the highest: Physical Health:12345678910 Emotional Health:12345678910 Mental Health:12345678910 Spiritual Health:12345678910 Social/Economic Health:12345678910 Health Specific Questions: Do you have any medical conditions that might restrict your full participation in this program? Please also list any physical limitations that may prevent your full participation. YesNo Emergency Contact: